Studies show that most people do not change their Medicare Part D or Medicare Advantage plan each year, even if they can save money on their prescription and medical costs. We can appreciate that, for some people, the value of consistency outweighs the potential for savings.
However, we want to remind you that, if you decide to stay with your current 2015 Medicare plan into 2016, your Medicare plan coverage and costs can change, so please take time to know how your current Medicare plan is changing in 2016.
What changes can you expect in 2016?
- Your 2015 Medicare plan may be discontinued in 2016. Although the 2016 Medicare plan landscape
is more stable than past years, some 2015 Medicare Part D and Medicare
Advantage plans will not be offered in 2016. If your Medicare plan is
not being offered in 2016, and you are not being reassigned to another
Medicare plan, you may be without Medicare plan coverage on January 1st. You can click here to read more in our article about plans affected by Service Area Reductions.
- Your 2015 Medicare Part D plan may be changing names in 2016.
Over 600,000 Medicare Part D beneficiaries will find that their 2015
Medicare plan’s name will change in 2016. For example, the 450,000
members of the 2015 Cigna-HealthSpring Rx Secure-Xtra (PDP) may notice
that their plan will become the 2016 Cigna-HealthSpring Rx Secure Extra (PDP) and, aside from the slight name change, will include some noteworthy changes in coverage. You can click here to see a few other example of 2016 Medicare Part D name changes.
- You may be automatically reassigned to another 2016 Medicare Part D plan.
Approximately 260,000 current members of stand-alone 2015 Medicare Part
plans will be automatically “crosswalked” or merged into another
Medicare Part D plan in 2016. For example, members of the 2015 SmartD
Rx Saver (PDP) will be automatically reassigned to the 2016 Express
Scripts Medicare - Value (PDP). You can click here to read more about 2016 Medicare Part D plan mergers or consolidations.
- 2015 Medicare Advantage plan members will also notice plan mergers and consolidations.
In addition to the statewide stand-alone Medicare Part D plan
consolidations, many 2015 Medicare Advantage plans will also be
terminated in 2016 or merged into other 2016 Medicare Advantage plans -
with some counties seeing significant changes in their Medicare
Advantage plan landscape. The counties seeing the largest number of
terminated 2016 Medicare Advantage plans are found in: Florida, New York, and Puerto Rico. For example, Twenty (20) of the 81 Medicare Advantage plans currently available Richmond County, New York are no longer offered in 2016. You can click here to read more about county-level changes in Medicare Advantage plans.
- Your monthly 2016 Medicare Part D premium might be increasing.
Without changing 2015 Medicare Part D plans, almost 6,000,000 Medicare
beneficiaries will see a monthly 2016 Medicare Part D premium increase
of over 20%. You can click here to see examples of 2015 Medicare Part D plans that are increasing their 2016 premiums.
- Your plan’s Initial Deductible (the amount you pay before coverage) may increase.
The standard 2016 Medicare Part D deductible will increase $40 to $360,
up from the standard 2015 deductible of $320. About 573,000 Medicare
beneficiaries are enrolled in 2015 plan that will see an even larger
initial deductible increase of up to $310. You can click here
to see an example list of Medicare Part D plan’s increasing their 2016
initial deductibles. The good news is that many Medicare Part D plans
are now exempting lower-costing drug tiers from the initial deductible.
Also, on a positive note, the 600,000 members of the 2015 First Health Part D Value Plus plan will notice that they now have a $0 deductible for 2016.
- Your 2016 Medicare drug plan’s formulary or drug list might cover fewer medications. Although some 2016 Medicare prescription drug plans will be adding more medications, based on our analysis,
over 10 million Medicare beneficiaries currently enrolled in a
stand-alone Medicare Part D plan will see at least 100 medications
removed from their 2016 formulary. Please remember that a larger
Medicare Part D plan formulary does not necessarily mean you will get
more of your medications covered. Be sure to check to make sure your
medications are affordably covered by your chosen 2016 Medicare Part D plan.
- Your 2016 Medicare plan’s prescription drug cost-sharing (co-payments) might increase.
In other words, if you are currently paying $1.00 for a generic
prescription in 2015, you may be paying $4.00 in 2016 for the same
medication. You can click here
to see an example of how the 2016 SilverScript Choice Medicare Part D
plan will add a new drug tier to the 2016 plan formulary and change the
cost-sharing design.
- Your Medicare prescription drug plan may be using preferred pharmacies. For example, the First Health Part D Value Plus PDP
in Washington State uses preferred network pharmacy pricing and the
co-payment for a Tier 1 medication is $1.00 at a preferred network
pharmacy and, for the same Tier 1 drug, a $10.00 co-pay when purchased
at a non-preferred network pharmacy. You can contact your plan’s Member
Service department to find preferred pharmacies in your area.
- Some
2016 Medicare Advantage plans will offer a variation on the standard
drug plan Initial Coverage Limit of $3,310, with 2016 Initial Coverage
Limits ranging from $2,550 to $8,000. You can click here to read more about 2016 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.
- Your 2016 Medicare Part D plan Donut Hole or Coverage Gap benefits can change.
Some good news: the standard 2016 Initial Coverage Limit has increased
to $3,310 (meaning the you can purchase medications with a retail value
up to $3,310 before entering the 2016 Donut Hole) and, if you do exceed
your drug plan’s Initial Coverage Limit, the 2016 Donut Hole discount will continue to provide a 55% discount for brand-name drugs and the generic drug discount will increase to 42%.
- Your 2016 Medicare Part D plan may no longer qualify for your State’s Low-Income Subsidy (LIS) $0 premium.
In 2016, most states will have fewer Medicare Part D plans qualifying
for the state’s Low-Income Subsidy (LIS) $0 premium. The state offering
the smallest selection of $0 premium LIS plans is Hawaii,
with only two (2) 2016 $0 premium LIS plans (down from nine (9)
qualifying 2015 Part D plans). For more about the decline in the number
of LIS $0 premium plans, you can click here
for our article “Q1Group analysis of the 2014 to 2016 decline of
Medicare Part D plans qualifying for the Low-Income Subsidy (LIS) $0
premium”.
- Your Medicare Advantage plan’s provider network may change.
During the past several years some Medicare Advantage plan members have
found that their healthcare providers were dropped from the plan’s
network. Remember, even though you have checked to ensure that your
healthcare providers are included in your Medicare Advantage plan's
provider network, it is possible that your plan’s network will change
during the plan year. Although Medicare has established a Special Enrollment Period
(SEP) allowing you to change Medicare plans if your plan makes
significant mid-year network changes, it is not yet clear when this SEP
will be applied.
- Your 2016
Medicare Advantage plan’s Medicare Part A and Part B maximum
out-of-pocket (MOOP) limit may be reduced below the $6,700 maximum.
In 2016, more Medicare Advantage plans will offer a lower Medicare Part
A and Part B Maximum Out-of-Pocket (MOOP) Limit down from the $6,700
maximum. The number of 2016 Medicare Advantage plans having the
statutory maximum MOOP will decrease to 33% -- down from 48% in 2015.
You can click here to learn more about the Maximum Out-of-Pocket Limits for 2016 Medicare Advantage plans and how MOOPs have changed since 2014.
Bottom Line: If you do not enroll into a new 2016 Medicare
Part D plan or Medicare Advantage plan, you will be automatically re-enrolled
into your current Medicare Part D or Medicare Advantage plan for 2016 and your
2016 Medicare plan may cost you more money and provide different coverage than
in 2015. If your 2015 Medicare plan is
being terminated in 2016 and you are not merged or “crosswalked” to another
2016 Medicare plan, you may be without Medicare plan coverage on January 1
st.
The Good News: You still have plenty of time to
review your 2016 Medicare plan coverage options during the annual Open
Enrollment Period that began on October 15
th and continues through
December 7
th.
How to learn more about the changes in your 2016 Medicare plan?
Your Medicare plan provider is required to summarize any Medicare
Part D or Medicare Advantage plan changes in your Annual Notice of Change
letter (ANOC) that you should have received in late-September or
early-October. If you have not received
a copy of your plan’s ANOC letter, please call your plan’s Member Services
department and ask your plan to send another copy.
Need a fast way to see how your Medicare Advantage or
Medicare Part D plan is changing in 2016?
Our
PDP-Compare
and
MA-Compare
tools allow you to compare changes in
all stand-alone Medicare Part D
prescription drug plans (PDPs) or Medicare Advantage plans (MAs or MAPDs)
across the country. Our comparison tools
show changes in monthly premiums and plan designs, as well as changes in co-payments
or co-insurance rates for different drug tiers. Both the PDP-Compare and MA-Compare also show the Medicare Part D plans
or Medicare Advantage plans that will be discontinued or added in 2016. The MA-Compare tool includes links to the
health coverage details of all 2015 and 2016 Medicare Advantage plans.
To see the annual 2015 / 2016 changes in Medicare Part D plan details, simply click on
your state:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY.
As a reminder: